Hello, DPC rebels and all those working with the resistance. This is my first contribution here on DPC News and I wanted to start with a bang–a two-part series on working with benefits advisors. When DPC docs work with employers, these advisors can make or break the deal, that is why in my book I call them miracle workers. When they do it right, with the right incentives and motives for employees and employers, it’s huge wins all around for everyone. Communication is critical on all sides: business owners, human resource folks, benefits advisors, and DPC physicians. So, over the next couple of weeks, we will look at critical conversations benefits advisors and DPC physicians should have to create a fully functional health plan for employers. Today, we start with questions every DPC physician should ask any benefits advisor before joining forces then next week we will flip the script. 

• What is your previous experience with direct primary care? What DPC docs have you worked with and when? Do you use a DPC doc yourself? 

            Most brokers (people that sell insurance and benefits plans for commission) and benefits advisors have heard of DPC by now but few know how to use it effectively in health plans. Most brokers will have no idea how to use it effectively as it won’t bring them revenue (no per member per month payments or commissions or kickbacks). They’ll see DPC as an “add-on” extra benefit that will only cost employers more money. 

            Benefits advisors worth their salt will be fully aware of the benefits and magic of DPC. They will make DPC the foundation of the health plan and make this clear to the DPC doc right up front. NO games or gimmicks to get you to participate, just your monthly fees paid from the employer to you. Also, find out who they’ve worked with before and talk to those DPC docs to learn all you can about the advisor. See if they use DPC for themselves and their family, a huge flashing positive sign. 

• How are you paid for your services and will the employer be told upfront? 

            Transparency in pricing is a must for all involved. While it is NOT legal for physicians to receive kickbacks for referrals, it’s common for everyone else in the medical community including brokers and benefits advisors. Ask them right up front, how do you get paid, commissions or consulting fees? The employer should really know this information as well. Beware any broker that wants to “bring you lots of employees for $5 PMPM of your fees.” These tactics are very shady and your fees should always be your fees, not a combination of third-party fees.  DPC docs should have a contract with and be paid directly by the employer, not a TPA or broker. In fact, if the broker wants you to have a contract exclusive with them that would be very concerning.  So, be sure that any contract you have is clear on these issues. Finally, if the advisors won’t tell you how they are paid, that is a huge red flag. 

• Are you appointed or associated with any major insurance plans (BCBS, United, Cigna, Aetna, or Humana, affectionately known as BUCAHs)? 

            As someone really smart once said, “no one can serve two masters.” An advisor can either work for the employer or the insurance company but not both. DPC docs need to know this information upfront, and employers do too. It is almost impossible to create an effective health plan with a BUCAH integrated with DPC as those fully funded plans already include primary care in the premiums. Even high deductible plans or Health Savings Account qualifying plans will likely not be cost-effective for employers or employees. Miracle-working advisors who craft self-funded plans outside of BUCAHs have every incentive to use DPC as the foundation to limit costs down the road. They want to use DPC as a cost-saving measure and wrap DPC into the plans. Many advisors have fully joined the resistance and renounced BUCAH plans altogether just like DPC physicians have done. Find those advisors and link up with them. 

• Have you crafted any health plans that integrate with DPC? Where and when? What DPC docs have you worked with on these plans? 

            This is really where the rubber meets the road, have they created any DPC miracles so far? You want to know who they helped and how it went. Find out the physicians they worked with so you can talk to them about any issues they had with the advisor. Find out if they would do anything different on plans moving forward. Crafting these DPC-integrated plans is not easy and takes a lot of work so finding an advisor with previous experience is a huge advantage. Suffice it to say, these types of plans are not conducive to “learning on the job”. 

• Can our DPC team be involved in employer meetings and plan design basics? Will we be able to be at the open enrollment meetings? 

            As mentioned above, communication is critical. For most employers and employees this will be their first time experiencing DPC. There will be a steep learning curve and that education needs to start as soon as possible. The employer will need to know a lot about how your DPC office operates, how you refer and to whom, what cost-effective services in the community can you connect them with, and any discount meds and labs you might offer. It should be a team attack to create an incredible well-rounded plan. Also, you will need to be involved in the open enrollment meetings to share your DPC clinic benefits with employees. The advisor should be making all these connections happen. If they are not involving you in meetings or are telling you, “no need for you to come” then you should be very concerned. Trust me, the employees will have no idea what DPC can do for them unless you are there to tell them. No one can tell your story for you. Ask to be involved and be warned if not. 

These five conversations are excellent starting points for DPC physicians to learn about benefits advisors. There are plenty of red flags gained here if this is a broker masquerading as a benefits advisor. Vetting the benefits advisor can save you so many headaches and wasted time. Do not skip this step in working with employers. 

Check back next week to see what questions benefits advisors and employers should ask DPC physicians to be sure they aren’t selling snake oil. Until then, keep the magic going.